Excellus agrees to cut red tape in N.Y. hospitals

After pressure from the Attorney General’s Office, procedures such as CAT scans will no longer require a tedious approval procedure.

Alex Bauer

An agreement between the Attorney General’s Office and the region’s largest insurer ensures that cancer patients get quicker service for a variety of common procedures.

Attorney General Andrew M. Cuomo and Excellus BlueCross BlueShield settled a dispute Tuesday dating to last fall after cancer patients and physicians complained about the time it took to get approval for CAT scans. Now, oncologists will not need to obtain approval before ordering the tests, according to the Attorney General’s Office.

Approval “was a huge, time-consuming process,” said Lyn Stanton, billing manager of the Finger Lakes Hematology and Oncology Practice. “This is a great thing for us.”

The outcry over so-called preapproval was aggravated by a proposed Excellus plan — now dropped — that would have quadrupled the number of tests required for approval.

Instead, the red tape has been reduced. Before the agreement was reached, 252 types of tests required approval from Excellus before physicians could perform them. Now, 125 tests require approval.

“Prompt diagnosis can be a matter of life and death,” Cuomo said. “Controlling costs need not mean compromising patient care. Today’s agreement strikes the right balance because all stakeholders — doctors, patients and insurers — had a voice in the solution. I applaud Excellus and CareCore for helping craft these reforms, which ended a cumbersome approval process and protects the integrity of the doctor-patient relationship.”

Also, the agreement waives the approval requirements for physicians whose requests for scans dealing with non-cancer patients are approved by Excellus at least 95 percent of the time.

Rochester-based Excellus is the largest non-profit insurer in the state, serving approximately 1.87 million people. CareCore is the largest radiology management company in the country, serving approximately 24 million people, according to the release.